Frequently Asked Questions

Frequently Asked Questions

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Identifying when study services can be billed to M

What clinical research items/services may be billed to a patient’s private third party payor (e.g. Aetna, Blue Cross, Blue Shield, etc.)?

Clinical research items/services may be billed to the patient’s private third party payor if the item/service is not paid by the study sponsor or promised free to the patient in the informed consent, AND:
the study is a Phase 1-4 therapeutic cancer trial (see California Health and Safety Code Section 1370.6; Cal. Ins. Code § 10145.4), OR
the commercial payor has pre-authorized the item/service for coverage, as a research-related item/service, OR
the commercial payor’s coverage terms otherwise provide coverage for the item/service when provided related to research. 4